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General NPI Number Information
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NPI Number | 1679779607
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Entity Type | Individual
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Provider Name | EARNEST FORD LPC
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Gender | Male
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 115 W SAGEBRUSH ST
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City | GILBERT
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State | AZ
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Zip | 85233-6916
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Country | US
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Telephone | 602-448-5970
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Fax |
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Provider Business Mailing Address
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Address Line | 2152 SOUTH VINEYARD BLDG. 4 STE. 109-1
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City | MESA
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State | AZ
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Zip | 85201-5661
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Country | US
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Telephone | 480-507-3340
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Fax | 480-507-3317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-13204
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License Number State | AZ
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